Healthcare Provider Details

I. General information

NPI: 1669409033
Provider Name (Legal Business Name): MIGUEL A MONTERO CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 08/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 NORTH MAIN
LOVINGTON NM
88260-2813
US

IV. Provider business mailing address

301 MEMORIAL MEDICAL PKWY URB JARDINES METROPOLITANOS
DAYTONA BEACH FL
32117-5167
US

V. Phone/Fax

Practice location:
  • Phone: 575-396-6611
  • Fax: 575-396-1454
Mailing address:
  • Phone: 386-231-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9193090
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number674130
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA-01274
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95000027
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number847033
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: